Estimated Global Proportions of Individuals With Persistent Fatigue, Cognitive, and Respiratory Symptom Clusters Following Symptomatic COVID-19 in 2020 and 2021.
Journal: JAMA
Volume: 328
Issue: 16
Year of Publication: 2022
Affiliated Institutions:
Institute for Health Metrics and Evaluation, University of Washington, Seattle.
Department of Juridical and Economic Studies, La Sapienza University, Rome, Italy.
Department of Pulmonary Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands.
John T. Milliken Department of Internal Medicine, Washington University in St Louis, St Louis, Missouri.
Epidemiology, Biostatistics, and Prevention Institute, University of Zürich, Zurich, Switzerland.
Wolfson Institute of Population Health, Queen Mary University of London, London, England.
Clinical Medicine (Pediatric Profile), I. M. Sechenov First Moscow State Medical University, Moscow, Russia.
EuroQol Research Foundation, Rotterdam, the Netherlands.
Pirogov Russian National Research Medical University, Moscow.
Department of Woman and Child Health and Public Health, Agostino Gemelli University Polyclinic IRCCS, Rome, Italy.
I. M. Sechenov First Moscow State Medical University, Moscow, Russia.
Department of Medicine, University of Washington, Seattle.
Center for Policy Impact in Global Health, Duke University, Durham, North Carolina.
Uppsala University Hospital, Uppsala, Sweden.
Pediatric Dentistry and Dental Public Health Department, Alexandria University, Alexandria, Egypt.
Rector's Office, I. M. Sechenov First Moscow State Medical University, Moscow, Russia.
Department of Surgical Sciences, Anesthesiology, and Intensive Care Medicine, Uppsala University, Uppsala, Sweden.
Clinical Medicine (General Medicine Profile), I. M. Sechenov First Moscow State Medical University, Moscow, Russia.
Administration Department, I. M. Sechenov First Moscow State Medical University, Moscow, Russia.
Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands.
Applied Physiology Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.
School of Nursing, Duke University, Durham, North Carolina.
Department of Rehabilitation Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands.
Department of Neurology, Medical University Innsbruck, Innsbruck, Austria.
Department of Infectious Diseases and Respiratory Medicine, Charité Medical University Berlin, Berlin, Germany.
Department of Respiratory Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands.
Department of Public Health Surveillance and Response, National Institute for Communicable Diseases, Johannesburg, South Africa.
Department of Infectious Diseases and Respiratory Medicine, Charité University Medical Center Berlin, Berlin, Germany.
Department of Epidemiology, Harvard University, Boston, Massachusetts.
Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
Russian Medical Academy of Continuous Professional Education, Ministry of Healthcare of the Russian Federation, Moscow.
Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.
Department of Pediatrics and Pediatric Infectious Diseases, I. M. Sechenov First Moscow State Medical University, Moscow, Russia.
Duke Global Health Institute, Duke University, Durham, North Carolina.
Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.
Department of Occupational Medicine and Public Health, Faroese Hospital System, Torshavn, Faroe Islands.
Department of Internal Medicine, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh.
Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
Hospital Universitario de La Princesa, Madrid, Spain.
Department of Global Health and Social Medicine, Harvard University, Boston, Massachusetts.
Department of Family Medicine and Community Health, Duke University, Durham, North Carolina.
Department of Political Science, University of Washington, Seattle.
Postgraduate Program in Epidemiology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.
National Center for Disease Control and Public Health, Tbilisi, Georgia.
School of Public Health, University of Queensland, Brisbane, Australia.
Department of Maternal and Child Nursing and Public Health, Federal University of Minas Gerais, Belo Horizonte, Brazil.
Clinical Epidemiology and Public Health Research Unit, Burlo Garofolo Institute for Maternal and Child Health, Trieste, Italy.
Department of Health Policy and Management, Keio University, Tokyo, Japan.
Department of Internal Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil.
Evans School of Public Policy and Governance, University of Washington, Seattle.
Cochrane South Africa, South African Medical Research Council, Cape Town.
Department of Orthopedic Surgery, Duke University, Durham, North Carolina.
Abstract summary
Some individuals experience persistent symptoms after initial symptomatic SARS-CoV-2 infection (often referred to as Long COVID).To estimate the proportion of males and females with COVID-19, younger or older than 20 years of age, who had Long COVID symptoms in 2020 and 2021 and their Long COVID symptom duration.Bayesian meta-regression and pooling of 54 studies and 2 medical record databases with data for 1.2 million individuals (from 22 countries) who had symptomatic SARS-CoV-2 infection. Of the 54 studies, 44 were published and 10 were collaborating cohorts (conducted in Austria, the Faroe Islands, Germany, Iran, Italy, the Netherlands, Russia, Sweden, Switzerland, and the US). The participant data were derived from the 44 published studies (10 501 hospitalized individuals and 42 891 nonhospitalized individuals), the 10 collaborating cohort studies (10 526 and 1906), and the 2 US electronic medical record databases (250 928 and 846 046). Data collection spanned March 2020 to January 2022.Symptomatic SARS-CoV-2 infection.Proportion of individuals with at least 1 of the 3 self-reported Long COVID symptom clusters (persistent fatigue with bodily pain or mood swings; cognitive problems; or ongoing respiratory problems) 3 months after SARS-CoV-2 infection in 2020 and 2021, estimated separately for hospitalized and nonhospitalized individuals aged 20 years or older by sex and for both sexes of nonhospitalized individuals younger than 20 years of age.A total of 1.2 million individuals who had symptomatic SARS-CoV-2 infection were included (mean age, 4-66 years; males, 26%-88%). In the modeled estimates, 6.2% (95% uncertainty interval [UI], 2.4%-13.3%) of individuals who had symptomatic SARS-CoV-2 infection experienced at least 1 of the 3 Long COVID symptom clusters in 2020 and 2021, including 3.2% (95% UI, 0.6%-10.0%) for persistent fatigue with bodily pain or mood swings, 3.7% (95% UI, 0.9%-9.6%) for ongoing respiratory problems, and 2.2% (95% UI, 0.3%-7.6%) for cognitive problems after adjusting for health status before COVID-19, comprising an estimated 51.0% (95% UI, 16.9%-92.4%), 60.4% (95% UI, 18.9%-89.1%), and 35.4% (95% UI, 9.4%-75.1%), respectively, of Long COVID cases. The Long COVID symptom clusters were more common in women aged 20 years or older (10.6% [95% UI, 4.3%-22.2%]) 3 months after symptomatic SARS-CoV-2 infection than in men aged 20 years or older (5.4% [95% UI, 2.2%-11.7%]). Both sexes younger than 20 years of age were estimated to be affected in 2.8% (95% UI, 0.9%-7.0%) of symptomatic SARS-CoV-2 infections. The estimated mean Long COVID symptom cluster duration was 9.0 months (95% UI, 7.0-12.0 months) among hospitalized individuals and 4.0 months (95% UI, 3.6-4.6 months) among nonhospitalized individuals. Among individuals with Long COVID symptoms 3 months after symptomatic SARS-CoV-2 infection, an estimated 15.1% (95% UI, 10.3%-21.1%) continued to experience symptoms at 12 months.This study presents modeled estimates of the proportion of individuals with at least 1 of 3 self-reported Long COVID symptom clusters (persistent fatigue with bodily pain or mood swings; cognitive problems; or ongoing respiratory problems) 3 months after symptomatic SARS-CoV-2 infection.
Authors & Co-authors:
Wulf Hanson Sarah S
Abbafati Cristiana C
Aerts Joachim G JG
Al-Aly Ziyad Z
Ashbaugh Charlie C
Ballouz Tala T
Blyuss Oleg O
Bobkova Polina P
Bonsel Gouke G
Borzakova Svetlana S
Buonsenso Danilo D
Butnaru Denis D
Carter Austin A
Chu Helen H
De Rose Cristina C
Diab Mohamed Mustafa MM
Ekbom Emil E
El Tantawi Maha M
Fomin Victor V
Frithiof Robert R
Gamirova Aysylu A
Glybochko Petr V PV
Haagsma Juanita A JA
Haghjooy Javanmard Shaghayegh S
Hamilton Erin B EB
Harris Gabrielle G
Heijenbrok-Kal Majanka H MH
Helbok Raimund R
Hellemons Merel E ME
Hillus David D
Huijts Susanne M SM
Hultström Michael M
Jassat Waasila W
Kurth Florian F
Larsson Ing-Marie IM
Lipcsey Miklós M
Liu Chelsea C
Loflin Callan D CD
Malinovschi Andrei A
Mao Wenhui W
Mazankova Lyudmila L
McCulloch Denise D
Menges Dominik D
Mohammadifard Noushin N
Munblit Daniel D
Nekliudov Nikita A NA
Ogbuoji Osondu O
Osmanov Ismail M IM
Peñalvo José L JL
Petersen Maria Skaalum MS
Puhan Milo A MA
Rahman Mujibur M
Rass Verena V
Reinig Nickolas N
Ribbers Gerard M GM
Ricchiuto Antonia A
Rubertsson Sten S
Samitova Elmira E
Sarrafzadegan Nizal N
Shikhaleva Anastasia A
Simpson Kyle E KE
Sinatti Dario D
Soriano Joan B JB
Spiridonova Ekaterina E
Steinbeis Fridolin F
Svistunov Andrey A AA
Valentini Piero P
van de Water Brittney J BJ
van den Berg-Emons Rita R
Wallin Ewa E
Witzenrath Martin M
Wu Yifan Y
Xu Hanzhang H
Zoller Thomas T
Adolph Christopher C
Albright James J
Amlag Joanne O JO
Aravkin Aleksandr Y AY
Bang-Jensen Bree L BL
Bisignano Catherine C
Castellano Rachel R
Castro Emma E
Chakrabarti Suman S
Collins James K JK
Dai Xiaochen X
Daoud Farah F
Dapper Carolyn C
Deen Amanda A
Duncan Bruce B BB
Erickson Megan M
Ewald Samuel B SB
Ferrari Alize J AJ
Flaxman Abraham D AD
Fullman Nancy N
Gamkrelidze Amiran A
Giles John R JR
Guo Gaorui G
Hay Simon I SI
He Jiawei J
Helak Monika M
Hulland Erin N EN
Kereselidze Maia M
Krohn Kris J KJ
Lazzar-Atwood Alice A
Lindstrom Akiaja A
Lozano Rafael R
Malta Deborah Carvalho DC
Månsson Johan J
Mantilla Herrera Ana M AM
Mokdad Ali H AH
Monasta Lorenzo L
Nomura Shuhei S
Pasovic Maja M
Pigott David M DM
Reiner Robert C RC
Reinke Grace G
Ribeiro Antonio Luiz P ALP
Santomauro Damian Francesco DF
Sholokhov Aleksei A
Spurlock Emma Elizabeth EE
Walcott Rebecca R
Walker Ally A
Wiysonge Charles Shey CS
Zheng Peng P
Bettger Janet Prvu JP
Murray Christopher J L CJL
Vos Theo T
Study Outcome
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